AFFIDAVIT OF CONSENT

I, _______________________________, Filipino, of legal age, single/married to

__________________________________ and resident of ______________________
_____________________________________, after having duly sworn to in accordance with law,
voluntarily depose and say:
1. That I am the father/mother of minor(s) _________________________________
________________________________________________________________________
___________________________ who is/are ________________________ years old;

2. That said minor(s) is/are applying for a Travel Clearance Requirements for Minors from DSWD
in connection with his/her forthcoming trip to the
__________________________________________________________;

3. That said minor(s) will be accompanied by his/her:

_____________________________________________________________________________
(relationship and name of person accompanying minor(s));

4. That though the minor’s father/mother is not here present, I am giving consent to said minor’s
travel in as much as:
______ said father/mother has earlier voluntarily and freely given his/her consent, with no
condition imposed whatsoever, and requested that said consent be relayed by me.
______ I have exclusive legal custody of minor (see attached divorce decree / death certificate /
etc.)__________________________________________________________________________
______________________________________________________________________________
(state appropriate reason)
5. That I assume responsibility for the issuance of the passport and for allowing the trip of said
minor and further assume any and all obligations consequent thereto; and

6. That I am executing this Affidavit to attest to the truth of the above statement in connection
with said minor’s application for a Travel Clearance Requirements for Minors from DSWD.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________ in the City of Panabo.

________________________________ ______________________________
NAME OF ACCOMPANYING ADULT AFFIANT
 ACKNOWLEDGEMENT AND PARENTAL CONSENT

Name of Student: ______________________ Year & Section: ________________

Date: _______________

This is to acknowledge receipt of the Notification letter regarding the 17th National Scout
Jamboree 2019.

I have read and understood the information regarding the intended activity to be given to
my child. YES, I will allow my child to be participated in the 17th National Scout
Jamboree 2019.

_______________________________
Name & Signature of Parent/Guardian